R 2014-162 Aging - Nancy Alton as wellness instructor

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ORANGE COUNTY-CONTRACT CONTROL SHEET Routing Order: (1)Department,(2)IT,(3)Risk Management,(4)Financial Services,(5)Attorney,(6)Manager,(7)Clerk This Document shall accompany all contracts and shall be submitted for signature in the Routing Order specified above. If the Manager determines the contract is not appropriate for Manager approval the Manager shall submit the contract for BOCC approval. Contracts for BOCC approval must be submitted through,and complete,the routing process prior to agenda review. Contracts for legal review should be completed through the legal review process prior to being routed for signature. Department Party/Vendor Name: Nancy Alto n Party/Vendor Contact Person: Contact Phone: Party/Vendor Address:3917 Marklyn Place City Hillsboroueh State:NC Zip:27278 Department:Aging Amount: $7,000 Purpose: Instructor Budget Code(s): 10430120- 630000-71085 Vendor#58145 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type:(Check one)New ❑ Renewal ® Amendment ❑ Effective Date March 25,2014 Approved by Board Yes❑No❑ Agenda Date: Title of Contract: Wellness Instructor If this is a Grant Agreement,pre-application has been approved by the Board of Commissioners Yes[]No[:]. If submitted for bid were bids/RFPs received Yes❑No❑ Bid/RFP number This contract has been reviewed and approved by the Department Director as to technical content: Department Director's Signature: 000 Date: IT Director (Applicable only to hardware/software purchases or related services)This contract has been reviewed and approved by the Information Technology Director as to technical content and information technology specifications: IT Director's Signature: Date: Risk Management Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; OR No Insurance Required ❑. Hold Contract pending receipt of Certificate of Insurance ❑. With incorporation of Insurance provisions as sho i�cgjr by the Risk Manager: L5 lUr �.. ; Risk Manager's Signature: (�� % ,�,�'� (�wu "" Date: MAR 2 _5 2014 Financial Services g This Contract is conditioned on appropriation by the Board of Commissioners Yes❑No[� A budge a It la before approval Yes❑No If budget amendment is necessary,please attach to this form. This instrument has been pre-audited in the manner required by the Local Government Bud C�td l Contr�T-l A ct: Financial Services Director's Signature: Date: ikfly County Attorney Approval by Board ❑ (Contracts $90,000.00 or more for goods or services, $250,000.00 or more for construction, or any BOCC consultant contract). Approval by Manager (Most other contracts$1,000 and above). Department Director approval only ❑ (Under $1,000). This contract has bec n iewe approved by the Attorney as to legal form and sufficiency: Attorney's Signature Date: At L County Manager This contract has been reviewed and is pro d b the County Manager Yes o❑. This contract has been reviewed s for nat by t h ' es o❑. Manager's Signature: Date: Clerk to the Board Approved by BOCC on the_day of ,20 . Submitted for Chair signature on the_day of ,20 Clerk's Signature: Date: Revised March 2012